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11 terms

NRP - Leson 3 Key Points

Ventilation of the lungs is the single most important and most effective step in cardiopulmonary resuscitation of the compromised newborn.
Indications for positive-pressure ventilation are:
a. Apnea/gasping
b. Heart rate less than 100 beats per minute even if breathing
c. Persistent central cyanosis despite 100% free-flow oxygen
Self-inflating bags:
a. Fill spontaneously after they are squeezed, puling oxygen or air into the bag
b. Remain inflated at all times
c. Must have a tight face-mask seal to inflate the lungs
d. Can deliver positive-pressure ventilation without a compressed gas source; user must be certain the bag is connected to an oxygen source for the purpose of neonatal resuscitation
e. Require attachment of an oxygen reservoir to deliver 90% to 100% oxygen
f. Cannot be used to administer free-flow oxygen reliably through the mask
Flow inflating bags:
a. Fill only when gas from a compressed source flows into them
b. Depend on a compressed gas source
c. Must have a tight face-mask seal to inflate
d. Use a flow-control valve to regulate pressure/inflation
e. Look like a deflated balloon when not in use
f. Can be used to administer free-flow oxygen
The flow-inflating bag will not work if:
a. the mask is not properly sealed over the newborn's nose and mouth
b. There is a hole in the bag
c. The flow-control valve is open too far
d. The pressure gauge is missing or the port is not occluded
T-piece resuscitators:
a. Depend on a compressed gas source
b. Must have a tight face-mask seal to inflate the lungs
c. Operator sets maximum circuit pressure, peak inspiratory pressure, and positive end-expiratory pressure (PEEP)
d. Peak inspiratory pressure must be adjusted during resuscitation to achieve physiologic improvement, audible breath sounds and perceptible chest movement
e. Positive pressure is provided by alternately occluding and releasing the hole in the PEEP cap
f. Can be used to deliver free-flow oxygen
Every resuscitation device must have:
a. A pressure release (pop-off) valve and/or
b. A pressure gauge and a flow-control valve
an oxygen reservoir must be attached to deliver high concentrations of oxygen using a self-inflating bag. Without the reservoir, the bag delivers only about 40% oxygen, which may be insufficient for neonatal resuscitation.
If there is not physiologic improvement and no perceptible chest expansion during assisted ventilation:
a. Reapply mask to face using light downward pressure and lifting the mandible up toward the mask
b. Reposition the head
c. Check for secretions; suction mouth and nose
d.Ventilate with the baby's mouth slightly open
e. Increase pressure of ventilations
f. Recheck or replace the resuscitation bag
g. After reasonable attempts fail, intubate the baby
Improvement during positive-pressure ventilation with a mask is indicated by a rapid increase in heart rate and subsequent improvement in:
a. Color and oxygen saturation
b. Muscle tone
c. spontaneous breathing
Current evidence is insufficient to resolve all questions regarding supplemental oxygen use for positive-pressure ventilation during neonatal resuscitation:
a. The Neonatal Resuscitation Program recommends use of 100% supplemental oxygen when positive-pressure ventilation is required during neonatal resuscitation.
b. However, research suggests that resuscitation with something less than 100% may be just as successful.
c. If resuscitation is started with room air, supplemental oxygen, up to 100%, should be administered if there is no appreciable improvement within 90 seconds following birth.
d. If supplemental oxygen is unavailable, use room air to deliver positive-pressure ventilation.